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4155340150 p.214-Sep-2017 18:27 <br /> <br />/ <br />Square Footage <br /> Milk Olepeneer -Nucntw ot Conialmws In Multi Hoad Unit <br />i <br />■Number of Units <br />O Local HW Cleanup Site <br /> Spa £3 Out of Sorvlo® PocWSpa <br />O Kennel <br /> Tattooing 0121) Body Plerolng 0120) Permanent Cosmetics 0122) <br /> 11 - 60 <br />Received Time Sep. 14. 2017 4:21PM No. 2303 <br />§ <br /> Vehicle # <br />-Number of Units _ <br />_____ _ Cotof <br /> fee Plant <br />O Produce Stand <br /> Pumper Vehicle Registration #.License U <br />J O Package Treatment Plant <br /> Rccyclo/Euompt Syetem (2200) <br /> Appliance Recycle) & (22 TZ) <br /> CwMUiiomiiiy txempt (CF.) <br /> PermiLBy Rule Huusehold Hfizmdoua Wesle <br />Number of AST <br /> Skilled Nursing O Large Generator C <br />» Common Storage Facility 2 -10 <br />Capacity <br />C Chamloal Toilets <br /> Ag/Canrrwy Waste Stt® <br /> Procees/Rocyde Facility <br />D Dumpsters > 20 ou yd (# ot Umt») <br />4 <br />' **^7 <br />— Tons Generated Per Year <br />- Silver Only (2222) <br />— O Conditionally Authorized (CA) <br /> Pennlt-By-Rule Fixed Unit <br /> ABOVEGROUND STORAGE TANK FACILITY (AST) (2300) rL....:.„. 0 , <br />UNDERGROUND STORAGE TANK (UST) PROGRAM (2300) Uss US FA WldO f <br />tfCUSING PROGRAM (2400) <br />□ Hotel/Motol --Number of Units O Jail or Exempt Iwtltutiort <br />Employ*. Hcuslno (2700) Use HouitinQ/Lsbor Camp Appllcatiqn l-otm <br /> gjl.g MITIGATION (2900) VNi2£f^AQWI!ilQJNJE^Qt!LCQt£TB.QL (3000) <br />□ Environmental Assessment UST-CAP Site Local HW Cleanup Site □ NPUSEP Cleanup Site UIC Site <br />□ Abandons HW Site □ ncrvNPUSEP Cleanup Site O RWQCB Cleanup Site □ Water Quality Remediation Site <br />RECREATIONAL HEALTH PROGRAM (3600) <br />Number of Pouls/Spas at Factlity Pool <br />VECTOR CONTROL PROGRAM (4000) <br /> Poultry Farm-------Maximum number of birds <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />-. _______ MASTERFILE RECORD INFORMATION FORM _____ <br /> Progrepi »< Existing Facility ONew i'-H Progwn end New Facility <br />Program Record ID 7 J <br />Facility Address_^^3_Xia-a.-Uy.L. u.-.C'I <br />(Please check the epptopfiale description and specify site, nbrnbef df unite and pertinent |nto/-mp(iqn ) <br />Eaap-PROGRAM (1600) <br />□ Restaurant Seating Capacity Square Footage Food Handler* Courae rsg.u(w,'& Yte Cl N<) <br />LJ Commissary Dry storage only with Food Preparation DVending MachinesNuntbat of Unite <br />LJ Retail Market—-Sqirare footage with Meat Market only Mullipi® DrrpBrtiiwrUwa Ptepdckiifjad Clouds duly <br /> Mobile Food Vehicle-Make Vehicle Type Colw <br />Registrsbon #_________License # ___ Sticker fl* <br />□ Mobil. Food Prop Unit.. ___ Make """ / VahtefeTypn 777 <br />Rbg'stralion # License # Slicker B <br />□ SXlv r’fl,,?y ~Dates of wUon ftw"LJ Special Event Dates of operation from to ~ P <br />SALRY PROGRAM (2000) ‘ <br /> Grade A Dairy Gra<te g Dairy <br />SVf A State Facility Surcharge (2399) <br />HAZARDOUS WASTE PROGRAM (2200) <br /> Hazardous Waste Generator------ <br />O CRT Otteite Handlers (2218)-------- <br />Tiered Permitting Facility -------------- <br /> Pumper Yard <br />SOUP WASTE PROGRAM (4400) <br />O Landfill Trnntrfar Station <br /> Waste Tire Facility Compost Facility <br /> Refuse Vehicles <x tj unitr) <br />MEB1CAL WASTE PROGRAM (4500) <br />> Acute Care <br /> SludgrVAah Site <br />O CIA Landflit Site <br /> Farm/Ranch Cleanup Site <br />□ Traneter Station □ Veterinary Clinlf □ Xmmo^StoX^aTiX0□ 2 - W O*^ HaU'’r <br />(4600) Use &ltf9 APPliPat^ Form □ > 60 gerieretors <br />PhProgram Element I lgis' Fff nT~7 TT —-«r«. “in' ~ atoS“^“------------ ------- <br />——— Z W?